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General NPI Number Information
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NPI Number | 1912377375
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Entity Type | Organization
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Legal Business Name | TEXAS IOM LLC
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 23102 FRESCA ST
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City | GALVESTON
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State | TX
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Zip | 77554-1153
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Country | US
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Telephone | 713-992-3322
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Fax | 281-969-8709
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Provider Business Mailing Address
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Address Line | 23102 FRESCA STREET RR4 BOX 185X98
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City | GALVESTON
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State | TX
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Zip | 77554
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Country | US
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Telephone | 713-992-3322
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Fax | 281-969-8709
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Authorized Official
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Title or Position | CFO
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Name | MARTHA E PULLIAM
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Credential |
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Telephone | 713-992-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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